2019SUPREME BENEFIT GUIDE

2 UMVUZO HEALTH | SUPREME

WELCOME TO Umvuzo’s SUPREME OPTION

Your comprehensive healthcare solution.

Why choose Umvuzo?

We have been providing solutions for our members and their families since 2004. We are passionate about people, and show this in everything that we do.

In a recent independent brand audit our members said:

• We go the extra mile

• We are co-operative

• We listen

• We are flexible

• We give access

• We are member focussed

• We are affordable

• We are very inclusive

• We are quick to process claims

• We offer value in benefits

PRIMARY BENEFITSNO PRE-AUTHORISATION REQUIRED • SUBJECT TO FAMILY BENEFIT SCHEME RATES APPLY

GENERAL PRACTITIONER & SPECIALIST VISITS

OPTOMETRY

» Consultations » Minor procedures in the doctors’ rooms

» Eye test » Frames/lenses: limited to R2 780 per

beneficiary every 24 months

MEDICATION

» Scripted: acute medication as prescribed

ADDITIONAL CHRONIC MEDICATION (FORMULARY) » Scripted: 9 additional chronic conditions subject to available

funds in the family benefit and Disease Management Programme registration

OVER THE COUNTER MEDICATION » Limited to R1 920 per beneficiary per year, with a maximum

of R160 per event

FAMILY BENEFIT BREAKDOWN

MAIN MEMBERMAIN MEMBER +

ADULT DEPENDANT

MAIN MEMBER +ADULT DEPENDANT +

CHILD DEPENDANT x 1

MAIN MEMBER +ADULT DEPENDANT +

CHILD DEPENDANT x 2

MAIN MEMBER +ADULT DEPENDANT +

CHILD DEPENDANT x 3

R9 840 R17 640 R21 540 R25 440 R29 340

Main member Adult dependant Child dependant x 1 Child dependant x 2 Child dependant x 3 TOTAL FAMILY BENEFIT

M R9 840 R 9 840

M + A R9 840 R7 800 R17 640

M + A + 1C R9 840 R7 800 R3 900 R21 540

M + A + 2C R9 840 R7 800 R3 900 R3 900 R25 440

M + A + 3C R9 840 R7 800 R3 900 R3 900 R3 900 R29 340

M Main member A Adult dependant 1C Child dependant x 1 2C Child dependant x 2 3C Child dependant x 3

FEMALE HEALTH

» Oral contraceptives limited to R140per registered female per month

» Pap Smear » Mammogram » HPV vaccine (from the age of 9 years) » Laparoscopic sterilisation *

DENTAL CARE

» Consultations » Cleaning, fluoride treatment,

scaling, polishing » Fillings » Wisdom teeth extraction (in the

dentists’ rooms) » Dentures

MALE HEALTH

» PSA » Circumcision * (boys up to the age

of 12 in-hospital and over 13 in doctors' rooms only)

» Vasectomy *

* Pre-authorisation is required before accessing these benefits

ABOUT THE SUPREME OPTIONTHE SUPREME OPTION is a traditional, fee-for-service Option. Members have the freedom to choose any provider of choice for their every day needs. For all these day to day needs members are allocated a generous family benefit.

All secondary and hospital benefits must be pre-authorised beforehand.

This Option is well suited for those individuals who need generous cover and benefits without compromising their freedom.

3UMVUZO HEALTH | SUPREME

DISEASE MANAGEMENTACTIVE DISEASE MANAGEMENT PROGRAMMES

» Our Active Disease Management Programmes enable us to plan and co-ordinate the healthcare of members living with chronic medical conditions, in order to give them the best possible outcomes.

All 26 diseases on the CDL (Chronic Disease List) are covered as part of your PMB (Prescribed Minimum Benefits).

Registration on these Disease Management Programmes is necessary to access full benefits: » HIV/Aids » Oncology » Diabetes » Musculoskeletal » Renal » Hypertension » Hyperlipidaemia (high cholesterol) » Asthma/COPD/Bronchiectasis

A total treatment plan for each member includes: » Confidentiality » Ongoing member support and education » Individualised treatment plan » Ongoing counselling and health

monitoring

All Prescribed Minimum Benefits are covered according to Scheme rules, protocols and formularies.

UMVUZO ABBREVIATION DICTIONARYGP - General Practitioner • DSP - Designated Service Provider • CDL - Chronic Disease List • PMB - Prescribed Minimum Benefits

SECONDARY BENEFITSPRE-AUTHORISATION REQUIRED • SCHEME RATES APPLY

SUPPLEMENTARY BENEFITSEMERGENCY MEDICAL SERVICES

» R4 850 per family per year• Occupational therapy• Podiatry• Dieticians• Psychology• Speech therapy and audiology• Physiotherapy, chiropractors &

biokinetics

» Netcare 911 » Medical and hospital

logistics services » Emergency road and air evacuation » 1 medicine bag per family

upon joining » 1 medicine bag refill per year

APPLIANCES (ORTHOPAEDIC/SURGICAL/MEDICAL) TERMINAL AND WOUND CARE

» R9 710 per family per year• Back/leg/arm/neck

support• Crutches post surgery• Surgical footwear• Respiratory oxygen

» R10 000 per family per year• The cost for all services related

to care for a terminal condition that do not conform to acute admission or services

INVESTIGATIONS (OUT OF HOSPITAL)

» Limited to R5 800 per family per year • X-rays and blood tests

HOSPITAL BENEFITSUNLIMITED • PRE-AUTHORISATION REQUIRED • SCHEME RATES APPLY THIS OPTION USES ALL HOSPITAL GROUPS

GENERAL ACCOMMODATION

» Consultations (GP and specialists) » Treatment » Surgical procedures » Non-surgical procedures » Anaesthesia

» General ward » High care » Intensive care unit (ICU)

SCANS(IN & OUT OF HOSPITAL)

DISCHARGE MEDICATION

BLOOD TRANSFUSION

» 2 scans per family per year• RT scan• MRI scan• CAT scan

» 7 days' supply of acute or chronic medication

» 100% of the cost, including the cost of:• Blood• Apparatus• Operator's fee

OVERALL PROSTHESES INVESTIGATIONS

» R57 250 overall per family per year The following sub-limits are applicable:

• Vascular R37 650• Joint replacement R37 500• Functional R13 290• Major musculoskeletal R22 580

» Radiology » Pathology » Medical technology

KINDLY NOTE• Penalties will apply if authorisation is obtained after treatment.• The claim may not be paid if pre-authorisation is not obtained.• The Scheme rules supersede the information on this brochure.

WHAT IS THE MONTHLY COST? PER

MAIN MEMBERPER

ADULT DEPENDANTPER

CHILD DEPENDANT

R2 219.00 R2 086.00 R732.00

CONTRIBUTIONS: FULL DEAL

SINGLE MEMBER

CONTRIBUTIONR2 219.00

DUAL PARENT FAMILY

CONTRIBUTION R4 305.00 R5 037.00 R5 769.00 R6 501.00

SINGLE PARENT FAMILY

CONTRIBUTION R2 951.00 R3 683.00 R4 415.00 R5 147.00

IMPORTANT CONTACT INFORMATION

Alenti Office Park, Building D, 457 Witherite Road, The Willows, Pretoria, 0040PO Box 1463, Faerie Glen, 0043

24 Hour Call Centre and Authorisations: 0861 083 084

Please Call Me: 082 416 9898

Tel: 012 845 0000Fax: 086 670 0242E-mail: info@umvuzohealth.co.za

www.umvuzohealth.co.za

HOW DO I GET A PRE–AUTHORISATION NUMBER? » Call us on 0861 083 084 » E-mail: authorisations@rxhealth.co.za » We will access your medical history immediately and assist you with

obtaining any information you may need

PLEASE BE READY TO SUPPLY THE FOLLOWING INFORMATION WHEN CALLING UMVUZO HEALTH » Umvuzo Health membership number » Surname » South African ID number » Passport number (if you are from a neighbouring country)

Administrative services are attended to during business hours from:

MONDAYS TO FRIDAYS08:00 - 18:00SATURDAYS08:00 - 13:00

COUNCIL FOR MEDICAL SCHEMESTel: 0861 123 267E-mail: support@medicalschemes.com complaints@medicalschemes.comWebsite: www.medicalschemes.com

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